38062_SPIVEY, ALLEN_20040330

DCAMA / ❑ DREDGE & FILL
GENERAL PERMIT
ENew ❑Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Applicant Name / ilf*N
Address `)c,C IdVe fatr 11 �vC
City iuh State ZIP ?S��
Phone # (` `y ) : 9- 9 J0 Fax # ( )
7
Authorized Agent
Affected CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA G HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
ORW: yes / no PNA yes / no Crit. Hab. yes / no
Previous permit #
Date previous permit issued
Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision �\� r `<a✓ I �� �1
City t'C; ! �elpv1i, ZIP_
Phone # ( ) River Basin -J P f ra k
Adj. Wtr. Body oiA4f- / l? f r sr (nat /man /unkn)
Closest Maj. Wtr. Body kJ w r c 2T P; vrR.-
Type of Project/ Activity `M`I / �+�f V"u 1. �. Nq �� G+ l, l �r x f, 4 (irf, '. 1 c a f : X ►i r
ruci , 4t woo s^ N ( !' ; si a )a i :; ' Ni G Fct . (Scale: N - � )
Pier (docengt _ k) length ' 'r A I
Platform(s)
Fing
Groi
n length
number
head/ Riprap length
channel
cubic yards
house/ Boatlift
h Bulldozing
eline Length
not sure yes no
bags: not sure yes no
ratorium: n/a yes no I
os: yes ham'
, � ,
er pier(s) I
I I
avg distance offshore �'� G�
max distance offshore
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check#
Permit Officer's Signature
3- 4- Dq 4- 3L.• tq
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
Application Fee(s) Check#
Permit Officer's Signature
3- 4- Dq 4- 3L.• tq
Issuing Date Expiration Date
Local Planning Jurisdiction Rover File Name

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythatthis project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑ Tar- Pamlico River Basin Buffer Rules ❑ Other:
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington
Regional Office (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office
Mailing Address:
1638 Mail Service Center
Raleigh, NC 27699-1638
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888-4RCOAST
Fax:[phone]
Elizabeth City District
1367 U.S. 17 South
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: [phone]
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-395-3900
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01

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■ Complete items 1, 2, and 3. Also complete
Item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
IN Attach this card to the back of the mailpiece,
A. Signature
X A
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ived by P ' Name) Date of
or on the front if space permits.
i, Article Addressed to:
Is very address different from item 1? C7 Ye:
If YES, enter delivery address belo,.v: ❑ No
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3. SS Ice Type
ii1 Certffled Mail ❑ Express Mall
❑ Registered ❑ Return Receipt for Merchandise
Q Insured Mail ❑ C.O.D.
4. Restricted Delivery? {Extra Flee) ❑ Yes
2. A.ticleNumber
(IPansfor from service label) II YY 77 V E' 'LJ
PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540

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■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
or on the front if space permits.
1. Article Addressed to:
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c(Ct�Wlott..t-ii-)C-27$ cY
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Addressee
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D. s pelivery address different from item 1? ❑ yes
ES, enter delivery address below: 13 No
3. Service Type
jK Certified Mail ❑ Express Mail
Q Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ G.O.D.
4. Restricted Delivery? (Ettra Fee,' [] Yes
2. Article Number - 7
(transfer from service label)
PS Form 3811, August 2001 Domestic Return Receipt 102595 -02-M-154o

AWNCENT RIPARIAN PROPERTY OINWE1R STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 7j)6 ", J l�J t`e.�J _ is
(Name of Property Owner)
property located at Lb % Z 3 Co ►n e -� l�.t
(Lot, Block, Road, etc.)
on P,Le- � U in � r- �er��' � ' , N.C.
(Waterbody) ('Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boadift/boathouse mu;St be set back a minimum distance of fifteen feet (I5) from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
I dQ wish to waive that setback requirement.
------------ .-----------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development}
-------------------------------- ----------------------------------------------------------------------------------
Signature
Prin: or Type Name
, -- S17) t xr-6 r--
Telephone Number
Date: zi / j

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MX ' ..MAIL + REMEN RCETU M . r
DIVISION Or' C:OASM MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER BORM
Nam -:of Is dlMdual applying for Permit: k1
Aetdt•oss oP Prope?rty �—� � ��� "�
(Lot or Street It, 5, rent or Road, City & County)
I Hereby certiFy t1rtat I own property adjacent to tt�c above rafereft.wd property. The individual
applying for this permit has described to n:c as shown on the attached drawing the devolopment
tt\ey are, propsing, A dewription or drawing, with dinlcnsionS, should be provided with this
letter,
I havo no obectior.s to this proposal.
ff you have objections to $vhal is being rropased, plcase wrlta tise Divtslon of Cr)astal
Afailagemcnt, llestmn Plaza 14 151-81 11,vy, 241 Morehead City, NC, 28557 or call (252) 808-
28081viJhlis 10 days of receipt of this ,notice. No respottse a conaered rite same as no objection
if You Nave been nolt nett by Cert(fled Maif,
WAIVER SECTION
I tinderslnnd 01at a pier, dock, Mooring pilings, breakwater, boat house, lift ar sandbags Must be
Set back it v1,111it',1i m distance of 15' from my area of ripariat► access unless waived by n18. (If you
wish to walva tho setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback rccluirement.
✓ 1 cfo not with to waivc tit^ 15' setback requirement.
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'l'elt;pilnno Number Wltll Area cadu